Which patients age < 50 with OncoType score < 11 do you offer ovarian suppression?

For T1-2N0 very low risk disease the TAILORx data demonstrated a less than 5% risk of distant recurrence regardless of clinical risk. (Sparano et al NEJM 2019) The majority of premenopausal were given tamoxifen alone. The absolute difference between tamoxifen and OFS/AI in such a low risk group would be negligible and not worth the side effects. It is not definitively known if OFS/AI is measurably better than tamoxifen in premenopausal N1 patients with very low scores, but could be considered. This last part is controversial as not everyone is comfortable using Oncotype in premenopausal node positive patients.